Substance use disorders among the baby boomer generation are steadily increasing, but knowledge and training satisfaction regarding older adult substance use disorders among behavioral health providers (BHPs) has not been explored. Using the Kirkpatrick evaluation model, this quantitative study involved an examination of the knowledge and training satisfaction of four behavioral provider groups: addiction counselors, licensed professional counselors, marriage and family therapists/social workers, and psychologists. Each participant (N = 154) completed a demographic questionnaire, satisfaction questionnaire, and the Alcohol and Older Adult Questionnaire to measure knowledge level on older adult substance use disorders. The results showed that licensed professional counselors held significantly higher levels of knowledge than any other BHP group. There were no significant differences between BHPs regarding satisfaction with training on older adult substance use disorders. No relationship was found between BHP satisfaction and BHP knowledge scores, even when considering the number of years, a BHP was licensed. Therefore, the findings of this study may encourage more training for BHPs aside from licenses professional counselors as well as future research on BHPs treating older adult substance use disorders.

One hundred eight individuals between the ages of 17 and 25 completed measures assessing identity style, family functioning, and substance use. Fifty-seven respondents were evaluated as they were applying for services at a local substance abuse treatment center. Fifty-one respondents were surveyed from a local university general education class. The identity style construct is a self-report measure that evaluates the problem-solving and decision -making strategies of respondents. These constructs echo Marcia's identity statuses with the Normative and Diffuse/Avoidant subscales being utilized in this study. Family functioning was also assessed by self-report and evaluated overall family functioning. A factor analysis of the substance use measure resulted in two factors that were defined as Gateway drugs (alcohol, tobacco, and marijuana) and Illicit Substances (cocaine, hallucinogens, etc.) and were assessed as either use or nonuse during the last 4 weeks. Findings support the identity developmental paradigm of problem behavior and suggest that Normative-oriented respondents reported less use of Gateway Drugs and more functional family attributes. Conversely, the Diffuse/Avoidant-oriented respondents reported more use of substances and less functional family attributes. Difficulties in measurement are presented as well as suggestions for family-based intervention strategies designed to reduce young adult substance use and abuse.

Service members and veterans of the current era, Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) are at a high risk for a variety of psychological disorders and physical health impairments. Common disorders among male service members and veterans include posttraumatic stress disorder (PTSD), substance use, and hypersexuality. Each of these disorders affect all aspects of an individual’s life and can deteriorate important interpersonal relationships or impair functioning in a variety of contexts. All these variables can affect sexual health and functioning in these service members. Sexual functioning is an important aspect of overall well-being, relationship satisfaction, and marriage satisfaction. Conversely, sexual dysfunction can create interpersonal distress in important relationships and decrease overall well-being. One of the most common forms of sexual dysfunction in males is erectile dysfunction, and rates of sexual dysfunction are higher among male service members. These rates increase for combat veterans with a posttraumatic stress disorder (PTSD) diagnosis compared to those who do not have the same diagnosis. To date sexual dysfunction has been associated with PTSD, substance use, and hypersexuality. The current study examines how each of these disorders together are associated with erectile dysfunction in a sample of OEF/OIF/OND service members and veterans (N = 213). Exploratory analysis breaks down PTS symptoms into seven separate symptom clusters in an effort to determine what types of symptoms are most strongly associated with erectile dysfunction. The study recruited a sample of service members and veterans via Facebook and asked them to complete a survey battery that covered sexual health and assessed for PTSD, substance use, and hypersexuality. PTS symptoms were significantly associated with erectile dysfunction, in particular anhedonia and dysphoric arousal symptoms accounted for the most variance in this sample. Further research with clinical samples may strengthen these results or indicate additional symptom clusters that should be targeted in treatment and screening.

Magister Artium (Psychology) - MA(Psych) / The stage of adolescence is a transitional stage in human development that can be confusing and stressful as it involves adjusting to adulthood which comes with independence and responsibilities. Adolescents solidify their journey towards self-identity as they gradually detach from being completely dependent on their parents. They form new bonds with peers and other people and are bound to be experimental as they embark on a life discovery journey. Studies reveal that adolescents are increasingly engaging in risk-taking behaviours such as risky sexual behaviour, substance use and violence, despite the implementation of numerous behavioural change interventions

Indiana University-Purdue University Indianapolis (IUPUI) / Adolescents are at disproportionate risk for health consequences associated with risky sexual behavior (RSB), including sexually transmitted infections and unintended pregnancy. Racial disparities have also been observed with African American adolescents experiencing higher rates of such negative health outcomes than their White peers. Substance use, particularly alcohol and marijuana use, has been shown to predict RSB among adolescents of both racial groups. However, research suggests that alcohol use is more predictive of RSB in White adolescents than African American adolescents, perhaps due to significantly higher rates of alcohol use among White adolescents. Given recent trends indicating higher rates of marijuana use among African American adolescents than their White peers and a strong association between marijuana use and RSB among African American adolescents, marijuana use may better explain the relationship between substance use and risky sexual behavior among African Americans than alcohol use. Thus, the current study examined whether alcohol and marijuana use have differential effects on adolescent RSB by race at the event- and global-level of analysis. To that end, 113 adolescents ages 14-18 (African American = 93, White=20) completed self-report measures of substance use and RSB. Contrary to hypotheses, results revealed no racial differences in the relationship between substance use and RSB. However, post-hoc analyses revealed that marijuana use significantly predicted frequency of sex among African American adolescents above the effects of alcohol. These findings indicate that previously documented racial differences in the relationship between substance use and RSB may not be accounted for by marijuana use, but suggest that future studies continue to examine the unique impact of marijuana use on RSB, particularly among African American adolescents.

Indiana University-Purdue University Indianapolis (IUPUI) / According to the US government, nearly 1 in 5 Americans live in rural areas. In general, rural Americans have poor health outcomes, including higher rates of chronic disease, mental illness and certain types of substance use. A variety of different methods are used to assess rurality in health services research, making it challenging to precisely quantify the prevalence of mental illness and substance use in this population, as well as compare study conclusions. As policymakers become increasingly interested in addressing health disparities between urban and rural populations, it is important to assess and evaluate the different methods used to define rurality itself and determine how those methods affect estimates of depression and substance use, so that true disparities can be accurately captured and addressed. This dissertation will identify current definitions and methods used to measure rurality among published studies and then employ various identified methods to quantify the effect of measurement choice on prevalence of mental illness and substance use in rural populations. The dissertation will follow a three publishable paper model that will include a literature review and two empirical studies using secondary data as described below. For Paper 1, I identify peer-reviewed studies from HSR journals that use any method to measure rurality in their analysis. I analyze whether geographic units and methods used to classify rurality differ by focus area including costs, quality, and access to care. For paper 2, I quantify the impact of different measurements of rurality have on estimates for hospitalizations for depression and substance use. Using 5 different measurements of rurality, I calculate the levels of agreement as well as examine how characteristics of patients with depression or substance use disorder differ based on the definition of rurality used. In paper 3, I examine differences in the relationship between unmet mental health need and subsequent drug use in individuals with a history of depression. Using the National Survey on Drug Use and Health and a pooled crosssectional study design, I examine drug use by alcohol, marijuana, and prescription opioid use. Additionally, I compare self-medication and substance use in individuals by geographic location.

Indiana University-Purdue University Indianapolis (IUPUI) / Previous research has identified impulsive personality traits as significant risk factors for a wide range of risk-taking behavior, substance use, and clinical problems. Most work has been conducted in primarily White samples, leaving it unclear whether these patterns generalize to racial and ethnic minorities, who have higher rates of negative consequences of substance use behavior. The most widely used assessment of impulsive traits is the UPPS-P Impulsive Behavior scale, which has strong psychometric properties across demographic subgroups, such as gender and age; however, data supporting its use in racial and ethnic minorities is less well-developed. The aims of this study are to 1) examine the measurement invariance of the UPPS-P Impulsive Behavior Scale-Short Form (Cyders et al., 2014) across racial minority groups and 2) determine if impulsive personality traits differentially relate to substance use outcomes across racial groups. Participants were 1301 young adults (ages 18-35, fluent in English), recruited through an online survey for both college students at a large public university and Mechanical Turk, a crowdsourcing online platform. Measurement invariance was assessed using multigroup confirmatory factor analysis. Differential validity was assessed using a structural equation modeling framework. I established model fit for each racial group (White group: RMSEA= .067, CFI= .94; Black group: RMSEA= .071, 90% CFI= .952; Asian American group: RMSEA= .073, CFI= .94; Hispanic group: RMSEA=.081, CFI=.934). Based on change in CFI/RMSEA indices, I concluded strong measurement invariance of the Short UPPS-P as a valid scale of impulsive behavior across racial groups. In the White group, findings indicated significant relationships between multiple SUPPS-P traits and alcohol and substance use. In the Asian American group, positive relationships were found between sensation and alcohol use (p=.015) and negative urgency and drug use (p=.020). I found that there were no differences in the relationships between the Short UPPS-P traits and substance use outcomes across White and the racial and ethnic groups studied (p’s>.06).

With high rates of cannabis use in college students and increasing legalization of cannabis, psychometrically sound scales of cannabis consumption remain a high research priority. The Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU; Cuttler & Spradlin, 2017) assesses daily sessions, frequency, age of onset, and quantity of marijuana, concentrates, and edibles consumed. Preliminary psychometric properties have been established in a population of college students using cannabis legally. The current study aims to evaluate the psychometric properties of the DFAQ-CU in college students using cannabis illicitly. Participants (N=114) were 18- to 58-years-old (M=21.25). They completed the DFAQ-CU, Drug Use Disorders Identification Test (DUDIT), and Buss Perry Aggression Questionnaire (BPAQ). Analyses were performed using the original factor structures. The factor analysis will be replicated once the full sample has been obtained (~400 by 02/2021). Cronbach's alphas ranged from.32 to.92, with some factors showing stronger reliability (e.g., frequency) than others (e.g., daily sessions). Bivariate correlations indicated daily sessions (r(54)=.32, p=.02), frequency (r(53)=.50, p<.001), marijuana quantity (r(78)=.32, p=.004), and edible (r(25)=.54, p=.006) factors demonstrated high convergent validity with the DUDIT total score. The age of onset and concentrate quantity factors did not. All factors were significantly divergent from the BPAQ. Overall, the original six-factor scale appears to have a poor fit within a college student population with illicit use. Notably, the concentrate quantity and daily sessions factors have poor internal consistency and convergent validity. These will be further explored upon completion of data collection.

Many caregivers for children of incarcerated parents report that they struggle to speak with children about their parent’s incarceration or substance use (Manby et al., 2015; Smyke, Bailey & Zeanah, 2017). Children’s picturebooks are promising tools to aid caregivers in this regard (Colomer et al., 2010; Lowe, 2009: p. 3; Wolf, 2017). However, research that explores the content of children’s picturebooks as effective communication tools on the topics of parental incarceration and substance use is limited. This thesis uses arts-based methods including thematic narrative analysis, techniques of visual criminology, and autoethnography to explore the textual and visual narratives that are present in a series of picturebooks for children under the age of ten on the topic of parental incarceration and substance use. It also explores how these narratives resonate with my lived experience as the daughter of a former drug user and prisoner. Mobilizing a theoretical framework based on the sociology of emotions literature and picturebook studies (Hochschild, 1980; McCarthy, 1994), I conceptualize the role of specific emotions, including hope, in children’s literature. While the picturebooks accurately depict children’s emotional experiences when their parent lives with addiction or experiences incarceration, they fail to manage children’s expectations about the barriers their family may face when their loved one is released, such as barriers relating to poverty, mental illness, and relapse. The picturebooks in this study present young children with fairy tale endings and risk providing them with a false sense of hope regarding their parent’s release. Authors of picturebooks for children under the age of ten must consider how to balance truth-telling with age-appropriateness and the desire to provide young children with hope in these circumstances.

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